On May 18, 2026 (yesterday), South Africa’s Constitutional Court unanimously upheld a 2024 ruling from the Pretoria High Court, declaring Sections 36 to 40 of the National Health Act 61 of 2003 (NHA) unconstitutional and invalid.
QuickNews previously reported on the High Court judgement, which you can read about here. The Certificate of Need (CON) was part of 2003’s NHA, which was never implemented. Despite it not being a part of the 2023 NHI Act, the removal of the Sections was seen as undermining a core pillar of NHI – centralised management.
The case was brought by Solidarity Trade Union, the Hospital Association of South Africa (HASA).
It was argued that the CON unfairly constrained the rights of doctors to practise where they chose, and hospitals and other healthcare facilities would not be able to operate without one, nor for new facilities to open or even expansions to be made. The provisions, which aimed to promote equitable distribution of healthcare services, had not yet been implemented.
The Director-General of Health, who issued the CON, would have had exercised a “blunt instrument” to control private healthcare in the country, noted Judge Anthony Millar of the Pretoria High Court in his judgement.
The sections were found to be irrational and an unjustifiable limitation on the constitutional right (Section 22) to freely choose a trade, occupation, or profession. They granted overly broad discretionary powers without adequate safeguards. Finally, the court ruled that severing (removing) these sections entirely from the NHA was appropriate, with no need to refer them back to Parliament for fixing. The Health Minister and Director-General were ordered to pay costs.
Anton van der Bijl, Deputy Chief Executive of Solidarity, said: “The Certificate of Need was far more than merely an administrative instrument. It was an instrument of centralisation and state control.”
The Constitutional Court’s hearing over National Health Insurance (NHI) concluded on 7 May. The Board of Healthcare Funders (BHF) and the Western Cape Provincial Government made a combined application challenging the NHI Act on public participation grounds.
The Court is now deliberating; on such complex constitutional matters, it can be weeks to months before a judgment is made. The implementation of NHI remains suspended, following February’s High Court order – President Cyril Ramaphosa and the Minister of Health have formally undertaken not to proclaim or implement any part of the act until the Constitutional Court’s ruling. Other legal challenges are now paused.
What were the arguments?
The hearings focused on one key question: whether Parliament’s process met the constitutional threshold for public participation (primarily under Sections 59 and 72 of the Constitution). Section 59 mandates proactive, reasonable, and meaningful public engagement for the country’s participatory democracy. Formalities alone do not satisfy it – rather, the test is contextual reasonableness aimed at genuine influence. Constitutional Court challenges for national legislation are the main means by which Section 59 is enforced.
The BHF argued that hundreds of thousands of written submissions were effectively ignored; critical information was not provided; and whether, without such information, the test for rational law-making was met.
The Western Cape (led by Premier Alan Winde) focused primarily on deficiencies in the NCOP and provincial stages of the process, arguing that these violated constitutional public-participation requirements and undermined provincial roles. For example, the NCOP process was compressed into only eight weeks, key inputs were ignored, and provincial roles were undermined.
Parliament contended that the process was far more than a “tick-box” exercise, presenting the NHI to the public as a radical, transformative process and that details would only emerge as the project proceeded. [Nevertheless, even a simple calculation would show an NHI budget of R200bn, requiring crippling taxation.] They also argued that accommodations were made, such as extending written comment deadlines. They also argued that changes were made to the Bill, and that engagement does not mean that the legislature agrees, but rather is informed.
Judges raised questions about the integrity and practicality of the public health system in the context of NHI, but the core legal issue remained procedural compliance as opposed to the policy merits.
Is there precedent?
This would not be the first time the Constitutional Court has set aside Acts. In 2006, in a case brought by Doctors for Life, the Choice on Termination of Pregnancy Amendment Act and Traditional Health Practitioners Act were invalidated as Parliament had failed to comply with its section 72(1)(a) constitutional obligation to facilitate public involvement before passing.
Further cases reinforced that inadequate information, rushed timelines, and a lack of consultation over major changes would result in a breach. Parliament, however, argues that Doctors for Life shows that the requirement for participatory democracy has been met.
All parties now await the Court’s decision, which could either uphold the Act, declare it partially or wholly invalid, or remit aspects back to Parliament for correction.
Remaining passengers from the cruise ship MV Hondius, where an outbreak of hantavirus occurred, have now been evacuated after docking in Tenerife. So far, only three fatalities are reported, although the number of known infected cases has risen. Health organisations around the world are extending their support.
In a media briefing, Dr Tedros Adhanom Ghebreyesus, WHO Director-General said that eight cases have been reported so far, including three deaths. Five of the 8 cases have been confirmed as hantavirus.
According to the World Health Organization, the hantavirus in this case is the Andes virus, which is the only one capable of human transmission, albeit in an extremely limited fashion. Prolonged and close contact is required, as would happen on board a cruise ship.
Describing the situation, Dr Tedros said, “While this is a serious incident, WHO assesses the public health risk as low.” He noted that given the incubation period, “it’s possible that more cases may be reported.” Among medical support offerd, the WHO has distributed test kits from Argentina to five countries to support testing.
Prior to this incident, the most serious outbreak of Andes hantavirus was in Epuyén, Argentina, in late 2018 to early 2019 with 34 confirmed cases and 11 deaths (case fatality rate ~32%). Previously, very little was known about the Andes strain, explained Dr Gustavo Palacios, a microbiologist at Mount Sinai in New York, speaking to CNN.
“There is very limited experience handling this virus,” said Palacios, who had helped to trace how the virus spread. The study of the outbreak was published in 2020 in the New England Journal of Medicine.
“Probably we are having less than – I don’t know, I’m giving you a number, just for a ballpark number – 300 cases in history” of human to human transmission of Andes virus and about 3000 Andes cases overall, Palacios said.
Based on research into the Epuyén outbreak, Palacios said there seems to be only a roughly day-long window for transmission of the Andes virus of about a day, when patients first develop a fever.
Index case identified
The patients likely picked up the virus while they were on shore, before boarding the ship. The New York Post reports that Dutch ornithologist, Leo Schilperoord, was patient zero for the hantavirus outbreak. Along with his wife Maria Schilperoord, he visited a landfill outside of the city of Ushuaia to seek out a rare bird – birdwatchers frequent the landfill due to the number of birds flocking there. Argentinian authorities believe that it was there that he came in contact with long-tailed pygmy rats, inhaling particles of its faeces, which carries the Andes strain.
After boarding the ship with 112 others – including many other birdwatchers and scientists – he fell ill with diarrhoea and abdominal pain on April 6 and dying five days later. His wife was flying back with his body but collapsed when connecting in Johannesburg, and died in hospital the next day. Meanwhile, the UK man who was in intensive care in a Johannesburg hospital is now making a recovery.
It has long been known that heart attacks occurring in the morning are typically more serious than those that happen at night. While daily variations in stress hormone levels and blood pressure affect cardiac health, these are only part of the picture. There is also the diurnal variation in immune response involved: neutrophils, the body’s ‘first responders’, cause more inflammatory damage in the morning, causing havoc even as they neutralise pathogens.
“They’re the first sentinel, but they come fully loaded,” said Douglas Mann, MD, professor at Washington University School of Medicine in St Louis. “They’re shooting at everything and dumping a lot of toxic granules on the environment. They are indiscriminate in terms of their ability to destroy, and they take out healthy cells in the process.”
But exactly why they are more damaging at night has been a mystery. Now, researchers have found the reason behind this diurnal difference in destructiveness, and also how to tweak the ‘internal clocks’ of these white blood cells so that they cause less damage during sterile inflammation while still protecting against pathogens. Their findings are reported in the Journal of Exploratory Medicine, and are summarised in JAMA news.
Finding the pattern
The researchers, from Spain and Yale University, discovered that the timing of heart attacks significantly affects their severity due to a ‘neutrophil clock’ controlled by circadian rhythms. Neutrophils are more active during the day (activated by the Bmal1 protein) and less active at night (inhibited by the CXCR4 receptor).
Analysing more than 2000 patients with ST-segment elevation myocardial infarction, the researchers found that those who had an MI in the morning suffered worse cardiac damage than those who had them at night. Mouse experiments confirmed this pattern and showed that genetically disabling the Bmal1 protein reduced daytime neutrophil activity, protecting against severe cardiac injury.
This suggests a treatment strategy of tricking neutrophils into remaining in their nighttime inactive state, allowing doctors to reduce inflammation and lessen heart attack damage during daytime hours without compromising the immune system’s ability to fight infections.
Reducing cardiac damage without compromising the immune system
Mice engineered to have high levels of CXCR4 were given a drug compound, ATI2341, which bound to CXCR4 receptors. When heart attacks were induced, the mice showed reduced tissue damage. To test the neutrophils’ pathogen-fighting ability, they were also infected with Staphylococcus aureus or Candida albicans, but the mice were able to overcome the infection – the treated mice even tolerated the Candida infection better than the controls.
Mann explained why controlling the neutrophils was a better option. “Prior trials have tried to neutralise neutrophils or reduce neutrophil numbers entirely,” Mann noted. “But when you get rid of neutrophils, you’re also handcuffing the immune system. Before, it was considered an inevitability that neutrophils killing off infection also meant damaging a lot of tissue.”
The crucial question is of course whether this research in mice can translate to humans.
Luigi Adamo, MD, PhD, director of cardiac immunology at Johns Hopkins University who was not involved in the study, said that the study, one of the first use immune circadian rhythms to modulate inflammation, “offers new insight into neutrophils and a new way to look at this cardiac damage that might even apply to other types of sterile inflammation.”
Adamo struck a note of caution: the extremely low success rate in animal-to-human translation in cardioimmunology. “Immune cells are not always the same when you go from mice to humans,” he said.
Treatment implementation is a major obstacle
Even if this neutrophil clock alteration could be applied to humans, it would be difficult to administer since heart attacks strike without warning.
“If everyone took one of these drugs in the morning when they woke up, maybe it would make heart attacks less severe, but ‘preventive’ means you’re giving it chronically, and I don’t know what would happen with long-term stimulation of that receptor and other cell types,” Mann said. “Their data support the acute application, but in the long term, that’s a whole different story.”
As systemic treatment, the off-target effects of ATI2341 would need to be explored. He also struggled to envision a potential therapeutic solution.
“Today, when you have a heart attack, in most places with hospitals and well-developed health care systems, the patient gets an angioplasty,” Mann said. “The only time this drug could be given would be at the time of reperfusion, when you’re blowing up the balloon and opening up the clot.” Typically, ideal reperfusion timing is within two hours – but neutrophils probably do their damage within a matter of 30 minutes, Mann explained. “It’s a race against time, and I’m curious if [the researchers] can demonstrate that.”
Discovery Health has recently abandoned its efforts to reclaim roughly R170 million from 16 507 members following a widespread administrative error in processing medical claims. This happened after the successful intervention of the advocacy group MediCheck, which argued that the affected members were being unfairly penalised for a technical glitch which they had nothing to do with.
The glitch, which happened last year, resulted in over-reimbursement of certain medicine costs that occurred throughout 2025. Several specific technical and procedural issues were involved which caused the problem to grow undetected for nearly a year, as detailed by Moonstone.
The main error was that certain claims were incorrectly reimbursed at 100% of the Discovery Health Rate, regardless of the specific benefit limits that should have applied to those categories, when they should have been reimbursed at a lower rate.
Because these claims were incorrectly reimbursed at higher rates, they were inaccurately accumulated towards members’ benefit thresholds. This caused members who had Above-Threshold Benefit (ATB) as part of their plan to reach it prematurely. Upon reaching the ATB, subsequent medical claims were funded by the scheme. Normally, these claims would have been covered by the members’ medical savings accounts or out-of-pocket contributions.
Delayed detection allowed the problem to grow. The error was particularly difficult to identify because it was a “second-order impact”. The systemic failure only became apparent late in the year when members began reaching the ATB and the financial discrepancies were finally flagged.
This snowballing error eventually affected some 16 507 members on specific Executive, Comprehensive, and Priority plans. While Discovery Health initially sought to recover these funds, ranging from thousands of rand to as much as R80 000 per member, the Council for Medical Schemes stepped in to exert pressure amid widespread media coverage of the situation. Discovery gave in and committed to refunding any recovered funds and absorbing the total financial loss itself – estimated between R130 million and R170 million.
On Monday 22 September, US President Donald Trump made a widely-publicised announcement that paracetamol (acetaminophen/Tylenol) during pregnancy was confirmed as causing autism spectrum disorder (ASD). The claim – backed by a single, rather dodgy study – brings to a head long-standing concerns about the apparent, well-documented increase in ASD rates. QuickNews dives into the controversy to find out if there is any validity to the claims.
President Trump said, “With Tylenol, don’t take it. Don’t take it. And if you can’t live, if your fever is so bad, you have to take one because there’s no alternative to that, sadly,” adding that other medicines such as aspirin were also “proven bad”.
The announcement had been expected for some time and doctors, scientists and medical organisations were quick to respond. The president of the American College of Obstetricians and Gynecologists stated that the paracetamol–ASD claim “is not backed by the full body of scientific evidence and dangerously simplifies the many and complex causes of neurologic challenges in children”.
At the very least, such an announcement will causing pregnant women to second-guess their taking one of the few over-the-counter pain medications widely regarded as safe during pregnancy. In 2017, the X account for Tylenol stated “We actually don’t recommend using any of our products while pregnant.” But a major pharmaceutical manufacturer would want to protect itself from liability as broadly as possible. The politically-charged nature of the announcement has also seen pregnant women making TikTok videos of themselves apparently taking paracetamol (often with no reason to).
It is generally accepted that ASD is caused by a combination of genetics and environmental factors. About 1000 genes are believed to be related to ASD. And there is a very long list of possible risk factors, with an uncertain risk contribution: “Non-genetic factors mediating ASD risk could include parental age, maternal nutritional and metabolic status, infection during pregnancy, prenatal stress, and exposure to certain toxins, heavy metals, or drugs.”
Study validity questioned
To date, paracetamol during pregnancy had generally been linked by a number of poorly powered studies to a wide variety of outcomes: in addition to ASD, asthma, lower performance intelligence quotient (IQ), shorter male infant anogenital distance (predicting poor male reproductive potential), neurodevelopmental problems (gross motor development, communication), attention-deficit/hyperactivity disorder, poorer attention and executive function, and behavioural problems in childhood. A study of nearly 2.5 million children, the largest and most comprehensive do date, found a slight link for paracetamol exposure and autism – which vanished when controlled for sibling exposure (representing shared environment).
Before President Trump’s announcement, news releases on a review making the link were published some weeks before – QuickNews even covered it. The review, published in Environmental Health, selected certain related studies using the ‘Navigation Guide’ methodology – a non-quantitative methodology for the narrow use of inferring health impacts from environmental toxins, but was nevertheless used for pharmaco-epidemiology and teratology. According to Nathan A. Schacthman, legal counsel for scientific matters, the study has serious conflicts of interest: for example, last author Andrea A. Baccarelli is an environmental epidemiologist who has been involved with a lawsuit against manufacturers and sellers of paracetamol. In that lawsuit, his claims were thrown out on the basis of not having sufficient validity, including cherry-picked data and over-generalisation to distinct disorders (such as grouping attention-deficit hyperactivity disorder [ADHD] and other neurodevelopmental disorders). In addition, the study also made misleading claimed about being funded by the National Institutes for Health (NIH). Finally, although this is not mentioned by Schacthman, Robert F. Kennedy Jr. is also an environmental lawyer.
What’s this about a ‘cure’ for autism?
The bombshell announcement by President Trump came with an another bombshell announcement that there was ‘cure’ for autism. The cure is allegedly leucovorin – which sounds very impressive to the non-medical public. But leucovorin is merely folinic acid, which is a vitamer of plain old folic acid – aka vitamin B9. Folinic acid is on the World Health Organization’s essential medicines list. On the same Monday, the US Food and Drug Administration approved it for the treatment of ASD in children – bypassing the normal review process.
Can a simple medication – or rather, supplement – really ‘cure’ ASD, an extremely complex neurological disorder? The NIH funds about $300 million in ASD research annually, nearly double the amount in 2011. If anything, this has echoes of President Trump’s touting of hydroxychloroquine as a now-discredited cure for COVID in the height of the pandemic. It might indeed be beneficial if a patient had a bout of malaria and COVID at the same time, but was rapidly discredited.
The largest controlled study for the use of folinic acid supplementation plus usual care found only a modest ~1 point increase in the Childhood Autism Rating Scale (CARS) compared to usual care plus placebo.
There are also concerns about potential conflicts of interest. One of the manufacturers of folinic acid, iHerb, had the celebrity heart doctor Mehmet Oz as an investor, and is now the administrator for the Centers for Medicare & Medicaid Services (CMS), served until recently. CMS has however denied that Dr Oz will receive any financial reward from this.
But why are autism rates on the rise?
There are a few good explanations about why the rate of autism diagnoses is increasing, which do not depend on the addition of some new environmental variable. The first and most obvious is that there is increased awareness of this, and more referrals for assessment. A second reason is that the guidelines for diagnosis have become a lot less stringent. The definition of autism diagnoses, unlike schizophrenia, has drifted over time, with more “normal” people being likely to be diagnosed. The DSM-III of 1980 had more stringent criteria, for example, an individual needed to exhibit “a pervasive lack of responsiveness to other people” [emphasis added].
Introduced from 1994, the DSM-IV had broader criteria, and folded Asperger disorder into ASD. With the introduction of the DSM-V, new diagnoses were curbed – for a time. This is because about 20% of the children diagnosed with ASD under DSM-IV-TR would not have received one under the DSM-V. The DSM-V relaxed the criteria for language delay, co-occurrence, and IQ, making it easier for borderline cases to qualify for a diagnosis.
Another underappreciated element is that of social contagion. If parents know a family with a child with ASD, they may be more likely to seek a diagnosis. One study from California showed that ASD diagnoses were more likely the more other ASD diagnoses under one kilometre away.
Back to square one
Considering the weakness of the cited studies, the difficulty of explaining ASD, the underlying social phenomenon of shifting diagnostic thresholds and increased awareness, it seems as though these announcements are mostly without substance. In amidst the headline-grabbing news, the NIH quietly announced the launch of a $50 million initiative into the causes of ASD.
According to the news release, the NIH will fund 13 projects “that draw on genomic, epigenomic, metabolomic, proteomic, clinical, behavioral and autism services data. These projects will integrate, aggregate and analyze existing data resources, generate targeted new data and validate findings through independent replication hubs.”
With this in mind, it really doesn’t look like paracetamol is the singular, mysterious controllable risk factor for ASD rates that President Trump and Robert F. Kennedy Jr have made it out to be. Maybe paracetamol use simply reflects infection, or some other related factor.
A UK trial involving 16 500 mechanically ventilated intensive care unit (ICU) patients found no 90-day survival benefit for conservative supplemental oxygen over usual oxygen therapy. Nevertheless, the study, published in JAMA, did demonstrate the accuracy and cost-effectiveness of conducting a large trial with a simple intervention.
Oxygen is one of the most commonly administered treatments to patients in ICUs, but liberal oxygen therapy to avoid the risks of hypoxaemia may lead to harm, so finding the right level could optimise outcomes. Trials to date have shown mixed results.
For COVID patients admitted to the ICU with severe hypoxaemia, survival without life support was extended with conservative oxygen therapy. In a paediatric ICU study, conservative oxygen therapy resulted in a reduction in a composite of organ support at 30 days or death. A meta-analysis of 13 trials showed no differences between liberal and conservative oxygen therapy.
Even with just a small difference in survival benefit, with tens of millions of patients mechanically ventilated in the ICU would still mean significant numbers of lives saved. Other tests of new drugs and procedures in the ICU are hampered by high cost, as Seitz et al. noted in an accompanying editorial, so this sort of trial comparing two approaches to a common therapy is much more affordable.
The UK Intensive Care Unit Randomised Trial Comparing Two Approaches to Oxygen Therapy (UK-ROX) trial was initiated to determine if there was a difference between conservative and usual oxygen therapy.
The trial randomised 16 500 patients across 97 ICUs in the UK to either conservative oxygen therapy or usual oxygen therapy, in adults receiving mechanical ventilation and supplemental oxygen in the ICU. The primary outcome was mortality at 90 days. Conservative oxygen therapy targeted a peripheral oxygen saturation (Spo2) of 90% (range, 88%-92%), while usual oxygen therapy was at the discretion of the treating clinician.
Patients were early in mechanical ventilation (median, 5 hours), were severely ill (median predicted mortality risk, 35%), had a range of critical illnesses (eg, > 5000 patients with sepsis and > 1500 patients with hypoxic-ischaemic encephalopathy) and with significant hypoxaemia (eg, > 11 000 patients with a Pao2:Fio2 ratio, consistent with acute respiratory distress syndrome). Obtaining informed consent from the patients was, of course, largely not feasible, so this requirement was waived for the study.
Exposure to supplemental oxygen was 29% lower for those in the conservative oxygen therapy group compared with the usual oxygen therapy group. Of the patients randomised to conservative oxygen therapy, 35.4% died by 90 days compared with 34.9% of patients receiving usual oxygen therapy.
No differences were seen for secondary outcomes, including ICU stay, days free of life support and mortality at various time points. No interactions for confirmed or suspected COVID, ethnicity or other illnesses were observed.
Post hoc analysis showed weak evidence of increased harm from conservative oxygen therapy among the first 10 patients in each site but no difference for the random enhanced data collection sample compared with standard data collection.
Seitz et al. pointed out that the high level of adherence to the conservative target resulted in a mean oxygen saturation of 93.3%, versus 95.1% for usual care. The differences in oxygen saturation (1.9%) and Fio2 (0.04) between the trial groups in UK-ROX were about half the magnitude of some prior trials, due to not aiming for widely separated targets, and usual care varies considerably depending on location and clinical considerations.
Therefore, the researchers concluded that the findings do not support an approach of reducing oxygen exposure by targeting an Spo2 of 90% in mechanically ventilated adults receiving oxygen in the ICU. They suggest that future research may involve using AI to determine specific situations where conservative or liberal oxygen therapy may have beneficial outcomes.
References:
Martin DS, Gould DW, Shahid T, et al. Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients: The UK-ROX Randomized Clinical Trial. JAMA. 2025;334(5):398–408. doi:10.1001/jama.2025.9663
Seitz KP, Casey JD, Semler MW. Patient, Treatment, Outcome—Large Simple Trials of Common Therapies. JAMA. 2025;334(5):395–397. doi:10.1001/jama.2025.9657
A Korean population-based cohort study investigated the risk of Alzheimer’s disease (AD) among breast cancer survivors compared to age-matched controls without cancer. The study, published in JAMA Network Open, found that breast cancer survivors had an 8% lower risk of AD than controls, with a significant association in survivors over 65 years old – though the effect did not persist past five years. Radiotherapy was associated with a lower risk of AD among breast cancer survivors – but not other treatments.
Breast cancer survivors may experience long-term health consequences, including cognitive function and risk of dementia. The risk of AD among breast cancer survivors is still unclear and may vary depending on age at diagnosis, treatment received, and time since treatment.
Previous studies reported mixed results on the risk of AD among breast cancer survivors, with some finding no increase in risk and others finding a 35% increased risk for those diagnosed at age 65 or older. These studies have been hampered by a number of methodological issues, including not accounting for risk factors.
Cytotoxic chemotherapy can cause cognitive decline termed ‘chemobrain’. Other chemotherapy drugs such as anthracycline may reduced AD risk by reducing the formation of amyloid deposits. Endocrine therapy may increase the risk of dementia by lowering oestrogen, but studies suggest that the use of tamoxifen and aromatase inhibitors is associated with a lower risk of AD. An increase in dementia is seen in radiotherapy for head and neck cancers.
To investigate the risk of AD among breast cancer survivors, researchers used the Korean National Health Insurance Service (K-NHIS) database, exploring whether there is an association with cancer treatment and various confounding factors.
Among 70 701 breast cancer survivors (mean age, 53.1 years), 1229 cases of AD were detected, with an incidence rate of 2.45 per 1000 person-years. Survivors exhibited a slightly lower risk of AD compared with cancer-free controls, especially among individuals 65 years or older (SHR, 0.92; 95% CI, 0.85-0.99). But landmark analyses found that this lower risk did not persist beyond five years of survival. Radiotherapy was associated with reduced risk of AD among survivors, while chemotherapy and endocrine therapy had no significant impact. Anthracycline use, however, did show a non-significant decrease in risk.
Differences in doses and timing of radiotherapy may influence the effects. The incident exposure to the brain is estimated to be 0.2Gy from a breast cancer radiotherapy dose of 50Gy. A pilot study found that patients with AD who received low-dose whole-brain radiotherapy at 3Gy showed a temporary improvement in cognitive function. This improvement is believed to be due to a neuroprotective effect on microglia. Other studies have noted a transient risk reduction for AD in breast cancer radiotherapy; however, patients receiving radiotherapy usually do so in conjunction with breast-conserving surgery – those opting for this procedure are younger, with fewer comorbidities and smaller tumours.
The study suggests that cancer treatment may have benefits against AD development, but the risk of AD may differ depending on the duration of survival.
The findings indicate that breast cancer treatment may not directly lead to AD, and that managing modifiable risk factors for AD, such as smoking and diabetes, is a feasible option to lower AD risk among breast cancer survivors.
Neisseria gonorrhoeae Bacteria Scanning electron micrograph of Neisseria gonorrhoeae bacteria, which causes gonorrhoea. Captured by the Research Technologies Branch (RTB) at the NIAID Rocky Mountain Laboratories (RML) in Hamilton, Montana. Credit: NIAID. Photo by National Institute of Allergy and Infectious Diseases on Unsplash
In the midst of a record high in gonorrhoea cases, the NHS is to offer a gonorrhoea vaccine to gay and bisexual men with a history of multiple partners or a sexually transmitted infection (STI), the BBC reports. The gonorrhoea vaccination, which is actually a repurposed meningococcal vaccine, is estimated only to be 30–40% effective. Research shows, however, that this will be sufficient to reduce cases and their attendant costs to the NHS.
Gonorrhoea is caused by the bacterium Neisseria gonorrhoeae and is typically transmitted by having intercourse without a condom. It can cause pain, unusual discharge, genital inflammation and infertility. Evidence has shown that the MeNZB and four-component serogroup B meningococcal (4CMenB) vaccines, designed against Neisseria meningitidis, can also offer protection against gonorrhoea.
In 2023, there were more than 85 000 cases – the highest since records began in 1918. A study published in The Lancet estimates that gonorrhoea vaccination would prevent 100 000 cases, saving the NHS £7.9 million over the next decade.
While gonorrhoea is treatable with antibiotics, resistance is growing and there is concern that it may eventually become untreatable. According to The Guardian, some cases are now “extensively drug resistant” (XDR) – not responsive to ceftriaxone or the second line of treatment. There were 17 cases of ceftriaxone-resistant gonorrhoea between January 2024 and March 2025, the UK Health Security Agency (UKHSA) reported.
Over the same period, nine XDR cases were reported, while between 2022 and 2023, there were only five.
The people most affected by gonorrhoea in the UK are the 16 to 25 age group, gay and bisexual men, and those of black and Caribbean ancestry. The study’s scenario for vaccinating at-risk populations included those who had more than five sexual partners per year or who had a positive gonorrhoea test.
The vaccine, costing about £8 per dose, is cost-effective when administered to this at-risk group of men, rather than adolescents. Despite this, clinicians will be able to offer the vaccine to anyone who, in their judgment, would benefit from it. Other vaccines such as for mpox – another STI with high transmission between gay and bisexual men – and hepatitis will also be offered.
A court case over the trade names of two urinary tract infection (UTI) drugs has been settled. The court ordered that Cipla Medpro be restrained from using the trade name Furizome as it is too similar to Adcock Ingram’s UTI drug Urizone, leading to potential confusion by consumers. In his ruling, Justice James Lekhuleni of the High Court, Western Cape Division, who stated that despite safeguards against confusion in prescribing, ultimately “doctors are human”, so miscommunications could occur – and that the agency of patients cannot be ignored.
The trademark infringement case was brought by three applicants: Adcock Ingram Limited, Adcock Ingram Healthcare (Pty) LTD, and Italian company Zambon S.P.A. Zambon is the owner of the name Urizone, which is used under licence. Urizone had been launched in South Africa in 1993. The applicants stated that more than 3 million sachets had been sold between 2011 and 2023, with R5 million in advertising spent to promote the drug between 2018 and 2022 alone.
The applicants brought the case that Cipla Medpro’s Furizome, with the active ingredient fosfomycin, was too similar to their own product, Urizone, which contained the same ingredient in 3g sachets, and thus could confuse consumers. They alleged that Cipla Medpro sought to capitalise on the reputation earned by Urizone.
The applicants made the case that, despite Urizone being made available as a generic, none of the pharmaceutical companies producing it chose to use the name. When Furizome was launched, Adcock Ingram sent a letter of demand to Cipla to stop using the name due to its . Cipla, through its attorneys, rebutted the claim, saying that the two are sufficiently distinct to avoid confusion, with the “F” alluding to the fosfomycin ingredient. Cipla contended that it had already submitted the name through SAHPRA, and
Cipla also contended that the consumer – the patient – would not be misled during the prescribing and purchase of a schedule 4 medication as they would be informed by the pharmacist of the two different drugs.
In considering the judgment, the court noted that a test as to whether trademarks are be similar can be mode on a phonetic basis, or if they conceptually or visually similar. A trademark’s essential function is to indicate the origin of the goods in connection with which it is used. The “N” and “M” where seen as visually and phonetically similar, and “furi” was similar phonetically to “uri“. This could cause confusion and miscommunication even between doctors as to what drug they had prescribed a patient.
While Justice Lekhuleni acknowledged the safeguards of prescribing schedule 4 medications, he pointed out that the general public had become much more knowledgeable about prescription drugs in the past two decades. On this, he wrote “…the reality is that patients are involved in the process of deciding which medicines they will use, and that creates the risk of confusion. This situation in turn creates a responsibility upon pharmaceutical companies to make sure that they adopt trade marks that are not confusingly similar.”
